Anti-smoking drugs hystory

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‘Going Up In Smoke’ - Pharmacy and Smoking

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Since its arrival in Europe in the early 1500s, pharmacy and tobacco have had a long,
interesting, and at times contradictory, relationship.
This exhibition explores the development of this relationship, from the introduction of the
smoking of tobacco and other medicinal cigarettes to treat illness, to the development of
pharmaceutical products to aid smoking cessation.
When Christopher Columbus landed in
Cuba in November 1492, he saw local men
and women smoking what, he later found
out, was tobacco. Tobacco was imported
into Europe for the first time in 1556.
Europeans quickly tried this previously
unknown herb for recreational and medicinal
purposes. Between 1537 and 1559 at least
14 books mentioning medicinal tobacco
appeared in Europe. Aside from being
smoked, tobacco was used medicinally in
many forms including as an ointment, oil,
powder, syrup, gargle, and even as a smoke
enema. Sniffing powdered tobacco (i.e. as
snuff) was recommended to cure ulcers,
headaches and asthma. Tobacco was also
believed to treat shortness of breath, kidney
stones and stomach ache. During the Great
Plague of 1664 people smoked tobacco with
the belief that it would help them avoid
catching the disease.
Nicotiana Tabacum, L., lithograph by D. Blair, date unknown.
Tobacco: Some History
‘Going Up In Smoke’ - Pharmacy and Smoking

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Cigars. Coloured etching by Henry Heath, 1827. Published by S.W. Fores, London, 1827.
This caricature from 1827 takes a humorous look at people causing a nuisance by smoking in the street.
Even the children and monkey are smoking!
Image courtesy of the Wellcome Library, London.
Smoking tobacco for pleasure was already popular by the 1600s. However, in 1604 King
James I wrote a pamphlet criticising its use called A counterblaste to tobacco. He argued
that smokers’ internal organs were covered in soot and that they were wasting their money.
In 1828, two scientists, Wilhelm Heinrich Posselt and Karl Ludwig Reimann, isolated and
analysed the alkaloid in tobacco, nicotine, and discovered that it was a dangerous poison. In
spite of growing concerns, the recreational use of tobacco continued to increase. However,
the medical use of tobacco started to decline.

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This advertisement, published 100 years ago in the pharmacists’ trade journal The Chemists’ and
Druggists’ Diary, promotes the sale of tobacco products in pharmacies.
Advertisement, The Chemists’ and Druggists’ Diary, 1912
By the beginning of the 20th
century many chemists were also tobacconists, stocking
cigarettes and cigars as an extra source of income. As scientific evidence about the health
risks associated with smoking tobacco became more conclusive, the relationship between
pharmacy and tobacco again shifted. In Britain, it took until 1962 for the publication of a
report, by the Royal College of Physicians, explaining that smokers were exposing
themselves to high risks of serious disease. The report, Smoking and Health, clearly indicted
cigarette smoking as a cause of lung cancer and bronchitis and argued that it probably
contributed to cardiovascular disease as well.
The publication of the report led to a ban on advertising cigarettes on television from 1965.
In 1987 the Council of the Pharmaceutical Society of Great Britain concluded that ‘members
be informed that they should not sell tobacco or tobacco products, including cigarettes
containing tobacco, from registered pharmacy premises’. However, you could still buy
cigarettes from pharmacies until 2001. A complete ban on smoking in public places was
introduced in England on 1st
July 2007. A ban had already been implemented in Scotland
and Wales.

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Dutch Delftware tobacco jar, 1700 - 1799
This Dutch delftware jar labelled ‘Havana’ would have
been used in an apothecary shop for storing tobacco.
When tobacco was introduced into Europe in the 16th
century it was first used as a medicine. The ailments it
was taken for included wounds, headaches, catarrh,
chest complaints and childhood indigestion.
Arsenical Cigarettes
Manufactured by W. Martindale, 1904-1930
This cardboard box contains Arsenical
Cigarettes. The absorbent paper base of
each tobacco cigarette was impregnated with
the active ingredient arsenic. The Extra
Pharmacopoeia from 1928 states; “Arsenical
Cigarettes are made of paper impregnated
with sodium arsenate, so that each contains
3/4 grain (0.05 gm.) of the salt. The patient
ought to inhale the fumes deeply three or four
times”’. Bronchial and pulmonary conditions,
including chronic catarrhs, chronic phthisis,
spasmodic asthma, acute coryza, and hay
fever, were treated by smoking arsenical
cigarettes.
1.Tobacco as a Medicinal Treatment

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Why was smoking a medicinal treatment?
In the past medical professionals viewed smoking as an effective and legitimate medicinal
treatment. Primarily used to treat medical conditions of the respiratory system, smoking was
seen as one of the most effective ways to get the medicine straight to the lungs.
Aside from tobacco, other medicinal ingredients were smoked in cigars or cigarettes to treat
a number of respiratory conditions (or affections as they were then known), including
asthma, bronchitis, and hay fever.
Grimault's Cigarettes Indiennes
Manufactured by Grimault and Cie., Pharmaciens, Paris, 1897-1939
Grimault's Cigarettes Indiennes combined the active ingredients belladonna and cannabis Indica
extract. The cigarettes would have been smoked by the patient to relieve the symptoms of asthma,
bronchitis and coughs. Belladonna is powerful anti-spasmodic once used to treat spasmodic asthma.
2. ‘Asthmatic Cigarettes’ - Medicinal Cigarettes for
relieving Asthma, Bronchitis, and other Respiratory
Conditions (around 1870 - 1985)

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'Nutt Brothers’ Pectoral Cigarettes can be smoked by the most delicate lady or child'.
Leaflet advertising Nutt Brothers' Pectoral Cigarettes.
Manufactured by Nutt Brothers, 1877- 1893
Nutt Brothers' Pectoral Cigarettes were promoted as “A specific for Asthma, Bronchitis, and all other
Affections of the Respiratory Organ.' The ingredients are not known. However, the manufacturer’s claim
they are; 'Composed of renowned herbal materials, Warranted to contain no injurious ingredients'.
When smoking the cigarettes, the manufacturer’s advise; 'The smoke must be gently inhaled, and
allowed to flow through the respiratory passages ... so that the medicaments may have time to act...',
and that 'the cigarettes act most powerfully when smoked in a close [sic] room', with the patient sitting
quietly or lying down.

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'Jocigare' Anti-Asthmatic Cigares.
Manufactured by Wilcox, Jozeau and Company, Limited, 1941 - 1947
'Jocigare' Anti-Asthmatic Cigares are indicated on the box 'For the prompt relief of tightness of
breathing, shortness of breath, feeling of suffocation, and other distressing symptoms of asthma'. Each
cigar contains hyoscyamine (belladonna leaf alkaloids), powdered digitalis, and potassium nitrate. The
directions state; 'In smoking these cigarettes, inhale the smoke so as to introduce as much as possible
into the air passages'.

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The most common ingredient in asthma cigarettes is stramonium. Stramonium is the dried
leaves and flowering tops of Datura stramonium or Datura tatula. The medicinal action of
stramonium is due to the alkaloid hyoscyamine which relieves the spasm of the bronchial
tubes. In the treatment of asthma and other spasmodic respiratory conditions, stramonium
was given in tablets, mixtures, or smoked in cigarettes. However, by the early 1950s, the
smoking of stramonium in cigarettes was viewed by medical professionals as being of
limited value since the irritation produced by the fumes could aggravate bronchitis. Despite
this, stramonium cigarettes were manufactured until the mid 1980s.
Datura Tatula Cigarettes for Asthma
Manufactured by Savory and Moore, Limited. 1902 - 1931
Datura Tatula Cigarettes for Asthma were introduced by the manufacturer’s Savory and Moore in the
1870s as a remedy for asthma and bronchitis. Stramonium is the dried leaves and flowering tops of
Datura tatula. Savory and Moore claim on the packet; ‘The fumes of this Plant inhaled generally afford
instantaneous relief’.
3. ‘Asthmatic Cigarettes’ - Stramonium Cigarettes for
relieving Asthma, Bronchitis, Hay Fever (around 1870 -
1985)

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Potter's Stramonium Cigarettes
Manufactured by Potter and Clarke Limited 1941 – 1947
Potter's Stramonium Cigarettes were 'For the immediate relief of asthma, bronchitis, hay fever, and
spasmodic diseases of the respiratory organs'. The cigarettes contain 90% stramonium.
Potter's Asthma Cigarettes
Manufactured by Potter and Clarke Limited
1976 - 1984
Potter's Asthma Cigarettes, containing 98%
stramonium leaves, were 'For the relief of asthma
attacks and other spasmodic affections of the
respiratory tract'. The directions state; 'The smoke
should be drawn well into the lungs and retained
as long as possible, then expelled through the
nose and mouth’. Patients were advised; ‘Do not
exceed 6 cigarettes per day'.

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‘Smoking is a greater cause of death and disability than any single disease’;
The World Health Organisation
Smoking tobacco seriously damages the human body. There are around 12 million adult
smokers in the UK and smoking is still the largest preventable cause of premature illness
and death in the UK. One out of every two smokers will eventually die from a smoking-
related disease.
Smoking is associated with
around 50 diseases today,
including:
Coronary heart disease
Lung cancer
Stroke
Chronic bronchitis and emphysema
Shortness of breath
Increased coughing and sneezing
Gangrene
Reduced fertility
Defective vision
Pharmacy and Smoking Cessation
The Effects of Smoking

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Secret Remedies - Medicines for the Tobacco Habit 100 years ago
Consumer demand for anti-smoking treatments is not a recent
development. Even 100 years ago manufacturers were reacting
to the demand for preparations to help people quit smoking.
Their pharmacological effectiveness however is doubtful.
The book More Secret Remedies, published by the British
Medical Association in 1912, exposed the fraudulent claims and
revealed the ingredients of many proprietary medicines for the
first time. More Secret Remedies contains one anti-smoking
‘treatment’; Wood’s Cure for Tobacco Habit. This ‘cure’ consisted
of a complex system of 8 different tablets and pills to be taken
over a 72 hour period, a total of 125 doses; where after the
patient was guaranteed to be ‘cured’ of their addiction. The
British Medical Association was scathing in its criticism of the
preparation, since the tablets and pills only contained traces of aperients and tonics, and
three contained strychnine despite not being labelled a poison.
Victory Anti-Smoking Tablets. Manufactured by S.D. Ewen,
M.P.S., Dundee, 1950-1962
Promoted on the label with; 'Stop the tobacco habit', Victory Anti-
Smoking Tablets are a very early example of a pharmacist
formulating their own treatment to help patients give up smoking.
The tablets contain the active ingredients ferrous sulphate (iron
sulphate) and alum. Ferrous sulphate, an iron salt, was used in
the treatment of iron-deficiency anaemias. Alum precipitates
proteins and has an astringent action.
4. Early Anti-Smoking Treatments

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From the 1960s lobeline hydrochloride and lobeline sulphate were believed to be of value as
an anti-smoking deterrent. The pharmacological actions of lobeline closely resemble those
of nicotine. However, clinical trials of lobeline in the early 1960s led it to be considered by
the medical profession as being no more effective than a placebo as anti-smoking therapy.
Its use as an anti-smoking treatment had been withdrawn by the late 1980s - early 1990s.
Lobidan
Manufactured by Uni-Pharma Limited,
1961-1978
Lobidan tablets were indicated as a
'Smoking deterrent' containing 'Buffered
Lobeline'. The active ingredient lobeline
sulphate was used to reduce the craving for
nicotine and eliminate abstinence symptoms when giving up cigarettes. However, controlled trials of
lobeline sulphate (Lobidan) frequently found it to be no more effective than a placebo as a smoking
deterrent.
Antisol Anti-Smoking Aerosol.
Manufactured by Aerosmoke Limited, Newbury, Berkshire, 1967-1971
The Antisol Anti-Smoking Aerosol was used for administering the active
ingredient lobeline hydrochloride by means of an inhalation aerosol. The
recommended dosage was; 'Not more than 10 inhalations per day'.
Promoted on the packaging; ‘Lobeline is the nicotine substitute. Lobeline
smoke is the substitute for tobacco smoke'.
5. Lobeline Hydrochloride / Sulphate (1960 - 1990)

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Smokewatchers Anti-Smoking
Course.
Manufactured by
Smokewatchers, London, 1971-
1990
The Smokewatchers Anti-
Smoking Course contained;
Smokewatchers Aversion Therapy
Tablets, Nicotine Substitute
Pastilles, a Smokewatchers
Course Booklet and Instructions,
and a Smokewatchers Guarantee
Form.
The Smokewatchers Aversion Therapy Tablets contain silver acetate which produces an unpleasant
taste when combined with cigarettes. However scientists now believe there is little evidence that it has
any effect in promoting smoking cessation. The Nicotine Substitute Pastilles contained lobeline
hydrochloride.
Many people find nicotine cravings the hardest thing to handle about quitting smoking.
Nicotine Replacement Therapy (NRT) products were developed to give patients the extra
support needed to beat their physical addiction to nicotine. By easing the physical cravings,
patients find it much easier to overcome the psychological side of giving up smoking.
Treatment is usually required for three months and then gradually withdrawn. NHS research
shows that people who use Nicotine Replacement Therapy products and the other licensed
stop smoking medicines, used in combination with a local Stop Smoking Service are four
times more likely to stay quit.
Is taking nicotine replacement therapy safe?
Nicotine Replacement Therapy (NRT) is relatively safe and is not just swapping one
addiction for another. Unlike cigarettes, NRT does not contain tar, poisons or carbon
monoxide like cigarettes do, so it doesn't cause cancer. It is absorbed into the body in a
different way to the nicotine absorbed from cigarettes, and it is very much less addictive.
6. Nicotine Replacement Therapy (NRT)
(1989 - present day)

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NRT is currently licensed to be administered through chewing gum, transdermal patches,
lozenges, sublingual tablets, nasal spray, or inhalator.
Nicotine Replacement Therapy – Transdermal patches
Nicotinell TTS30 Patches - Manufactured by Zyma
Healthcare, 1996
Medical professionals believe nicotine replacement
transdermal patches are the easiest to use of all nicotine
replacement formulations and compliance is greatest with
this method.
Nicotinell Patches were designed in three sizes. As the
patient adjusted to not smoking he or she gradually
reduced the size of the patch. The large size higher
strength Nicotinell TTS30 Patches were for people who
smoke 20 or more cigarettes a day. Each patch contained
52.5 mg nicotine. When applied to the body, the nicotine in
the patch passes through the skin and into the body,
replacing the nicotine the smoker would normally get from smoking. The instructions state; ‘You must
not smoke whilst using these patches’.
Nicotine Replacement Therapy – Chewing Gum
Nicotinell mint chewing gum, 2 mg regular strength
Manufactured by Zyma Healthcare, 1996
Nicotinell chewing gum was to be chewed for up to 30
minutes when the patient felt the urge to smoke. The nicotine
released from the chewing gum is absorbed into the
bloodstream from the lining of the mouth, providing quick
relief from cravings. Regular strength Nicotinell chewing gum
contains 2 mg nicotine. Nicotinell chewing gum is also
available as 4 mg extra strength.

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Nicotine Replacement Therapy – Lozenges
NiQuitin.CQ Lozenges
Manufactured by SmithKline Beecham Pharmaceuticals
Ltd, 2002
NiQuitin.CQ lozenges containing 4 mg of nicotine were
intended; ‘For those who smoke within 30 mins of waking’. For
further support the manufacturers included a ‘Committed
Quitters Stop Smoking Plan’.
Nicotine Replacement Therapy – Sublingual Tablets
Nicorette Microtab
Manufactured by Pharmacia UpJohn, around 1999
Nicorette Microtab is a sublingual tablet containing 2 mg
nicotine. Rather than being chewed or swallowed,
sublingual tablets are dissolved under the tongue.

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What about electronic cigarettes?
‘Electronic cigarettes’, which administer
nicotine in the form of a vapour, are an
increasingly popular substitute for smoking
cigarettes. However, electronic cigarettes are
not currently licensed, or therefore regulated,
as medicinal products. Only licensed
medicinal products benefit from assurances of
quality, safety and efficacy.
The Royal Pharmaceutical Society does not
endorse the use of electronic cigarettes as a
form of treatment as their use may not be in
the interests of patients or the public.
Buspirone hydrochloride is an anxiolytic (anti-anxiety) agent, available only on prescription.
Although used primarily to treat very mild to moderate anxiety disorders, clinical studies in
the 1990s suggested that buspirone could be used to treat nicotine dependence. Some
clinical studies showed that in the short term buspirone could increase the number of
patients who were able to quit smoking. However it did not reduce the withdrawal symptoms.
By 2002 the use of anxiolytic (anti-anxiety) agents such as buspirone was no longer
recommended by medical professionals for smoking cessation.
Cox Buspirone Tablets 10 mg -
Manufactured by Alpharma A/S, 2001
These tablets contain 10 mg of the anti-anxiety
agent buspirone hydrochloride.
7. ‘Reducing the Anxiety of Quitting’ –
Buspirone hydrochloride (1996 - 2001)

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Bupropion hydrochloride is an anti-depressant, available only on prescription. However, in
smoking cessation, its action is said to be independent of its anti-depressant activity. It is
believed to act by increasing dopamine activity in the brain. It is given in a modified release
preparation, with treatment commencing 1-2 weeks before the patient attempts to stop
smoking, to allow steady-state blood levels to be reached. Treatment continues for a further
7-12 weeks. Bupropion has also been used with Nicotine Replacement Therapy, though
there is an increased risk of hypertension with this combination.
Zyban tablets - Manufactured by Glaxo Wellcome SA, 2000
Zyban tablets are a treatment to help patients give up smoking when they are addicted to nicotine. They
contain the active ingredient bupropion hydrochloride, in a prolonged release formulation. Patients start
taking the tablets while they are still smoking and set a ‘target stop date’ in the 2nd
week of treatment.
This is because Zyban’s prolonged release formulation needs time to start working.
8. ‘The Anti-Depressant’ –
Bupropion Hydrochloride (1999 - present day)

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Varenicline is a non-nicotine drug treatment designed to help smokers stop smoking. It is a
prescription only medicine (POM). Varenicline works primarily in two ways. Firstly, it reduces
the smoker's craving for nicotine by binding to nicotine receptors in the brain, reducing the
symptoms of withdrawal. Secondly, it reduces the satisfaction a smoker receives when
smoking a cigarette.
Champix tablets
Manufactured by Pfizer Limited, 2011
The brand name of varenicline in the UK is
Champix. Pfizer, the manufacturer of varenicline or
Champix, claim that clinical research shows that
with Champix the odds of quitting smoking are
twice that of buproprion and four times that of
placebo.
9. ‘Reducing Nicotine Craving and Withdrawal’ –
Varenicline (2006 - present day)

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Stopping Smoking requires commitment and planning. Pharmacists are among the most
accessible of healthcare professionals, with branches open in the high street at convenient
times. Therefore pharmacists are ideally placed to offer the public advice and information
about the benefits of stopping smoking and the support available.
Smoking cessation is the most common service provided by pharmacies in the UK and
many stock the quitting aids available. Aside from offering advice on pharmacological
treatments for smoking cessation, pharmacists also provide patient support, highlighting the
importance of will power and commitment when giving up smoking.
Services available may include: -
Carbon monoxide testing: this can be beneficial in assessing a smoker’s
status providing a pre quit level and a post quit level four weeks later.
Checking for COPD (Chronic Obstructive Pulmonary Disease): the
spirometer device measures the volume of air expelled in the first second of
forced expiration.
Behavioral and lifestyle advice, advice on withdrawal symptom
management: the pharmacist can suggest other ways in which the patient
can improve their overall wellness.
Drug therapies: pharmacist’s offer informed guidance on the
pharmacotherapy available.
Promotional beer mat
Distributed by the National Pharmacy Association,
2007
This beer mat, promoting the services that pharmacies
offer in helping with smoking cessation, was distributed
around pubs by the National Pharmacy Association at
the time of the Smoking Ban in 2007.
10. The Role of the Pharmacist in Helping with Smoking
Cessation

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Promotional postcard, entitled 'Quit Smoking with Will Power', 2007
Produced to coincide with the introduction of the smoking ban in England on 1st July 2007, the card
promotes Lambeth NHS Primary Care Trust's stop smoking service and highlights the role pharmacists
can play in helping an individual stop smoking.
NHS Smoke Free Quit Kit
Distributed by the National Health
Service, 2012
To encourage members of the public to
quit smoking these kits are being
distributed free of charge through
pharmacies, and the NHS Smoke Free
website www.nhs.uk/smokefree. The kits
contain a wide range of pharmacological
and non pharmacological support tools and
advice to help individuals successfully
through the process of quitting smoking.

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Useful Websites
England - www.nhs.uk/smokefree
England - www.nosmokingday.org.uk
Scotland - www.canstopsmoking.com
Wales - www.stopsmokingwales.com
Smoking Cessation Support Services